HHS Releases Final Rules on ICD-10, Electronic Transactions

Mar 01, 2009

The Department of Health & Human Services (HHS) has released two final rules “that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of a new generation of diagnosis and procedure codes and updated standards for electronic health-care and pharmacy transactions.”

The first final rule regards the replacement of ICD-9-CM codes — the codes that represent different medical diagnoses and procedures — with ICD-10 codes, which have been vastly expanded to cover new and future medical conditions and activities. The ICD-10 codes are scheduled to go into effect on Oct. 1, 2013.

The second final rule, HHS said in a statement, “adopts an updated X12 standard, Version 5010, for certain electronic health-care transactions, an updated version of the National Council for Prescription Drug Programs (NCPDP) standard, Version D.0, for electronic pharmacy-related transactions, and a standard for Medicaid pharmacy subrogation transactions. Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization and other administrative transactions. Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard.”